06 Evaluation of the national health.pmd

1Graduate School of Economics; 2Division of Environment and Resources, Institute of Economic Research, Kyoto University, Kyoto, Japan (Correspondence to N. Ghotbi: [email protected]). Received: 21/11/03; accepted: 08/12/03 ABSTRACT We reviewed the medical and economic burden of thalassaemia major with emphasis on prenatal diagnosis for disease prevention as the most economic health care policy approach. The current programme in the Islamic Republic of Iran screens couples just before marriage, identifies carriers and refers them for genetic counselling. We searched the current literature for a refined model and enquired into compliance issues in interviews with physicians, couples and families with affected children. The programme was unsatisfactory in comparison with comparable programmes in the Mediterranean region. We devised a simple decision tree that incorporates cost–effectiveness and technical, methodological and social issues that affect compliance. While revisions to the policy could improve efficiency, follow-up is needed, especially to provide prenatal diagnosis for carrier couples.